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Predictors and Direct Cost Estimation of Long Stays in Pediatric Intensive Care Units in Saudi Arabia: A Mixed
Mohamad-Hani Temsah1,2, Noura Abouammoh2,3, Ayman Al-Eyadhy1,2
1Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Reducing pediatric intensive care unit (PICU) length of stay (LOS) by transferring long-stay patients (LSPs) to step-down units (SDUs) can save millions. Factors like administrative constraints and complex cases prolong LOS, while clear policies shorten it.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Management
- Health Economics
Background:
- Pediatric intensive care unit (PICU) length of stay (LOS) is influenced by various factors.
- Understanding these factors and associated costs is crucial for optimizing patient care and resource allocation in PICUs and pediatric surgical cardiac intensive care units (SCICUs).
Purpose of the Study:
- To explore factors influencing long LOS in PICUs and SCICUs.
- To estimate the inpatient costs associated with long LOS.
- To determine potential cost savings from transferring long-stay patients (LSPs) to step-down care units (SDUs).
Main Methods:
- Multi-center, concurrent mixed-methods study in Riyadh, Saudi Arabia.
- Qualitative interviews with unit leaders using deductive content analysis.
- Microcosting to estimate inpatient costs for LSPs (≥60 days) and potential SDU transfer savings.
Main Results:
- Factors shortening LOS include: revised admission criteria, SDU transfer, family engagement, and national do-not-resuscitate (DNR) policy.
- Factors prolonging LOS include: administrative constraints, avoidance of code status decisions, lack of palliative care, and complex patient characteristics.
- Mean inpatient cost per LSP was SAR 3.63 million (USD 0.97 million); total cost for 48 patients was SAR 172.95 million (USD 46.12 million).
Conclusions:
- Transferring LSPs (≥60 days) to SDUs could save an estimated SAR 109.47 million (USD 29.19 million) for the studied patient sample.
- Further research with robust designs and diverse populations is needed to examine factors affecting LOS and policy effectiveness in resource management.
Background:
Several factors influence patients' length of stay (LOS) in pediatric intensive care units (PICUs). This study explored the factors and cost associated with long LOS among pediatric patient population across various PICUs and pediatric surgical cardiac intensive care units (SCICUs).
Methods:
This is a multi-center concurrent mixed-methods study that was conducted in different PICUs and SCICUs in Riyadh, Saudi Arabia. The units' leaders were qualitatively interviewed to explore the potential factors contributing to long LOSs in PICUs and SCICUs, and deductive content analysis was used. Microcosting was utilized to estimate the inpatient costs for a sample of long-stay patients (LSPs) and the potential cost savings if those patients were transferred to step-down care units (SDUs) for those who stayed ≥60 days.
Results:
Ten (90%) leaders of PICUs and SCICUs who were invited had participated. Changing the admission criteria, patient transfer to SDUs, family engagement in the decision-making process, and adopting a national do-not-resuscitate (DNR) policy were factors contributing to short LOSs. On the other hand, administrative constraints, staff avoidance of code status decisions, lack of palliative care resources, and complex patient characteristics were factors associated with long LOSs. The mean inpatient cost per patient was SAR 3.63 million (USD 0.97 million), and the total cost for the 48 patients was SAR 172.95 million (USD 46.12 million).
Conclusion:
If the recommendation to transfer LSPs after a 60-day PICU stay to SDUs is taken, the estimated cost savings among this sample of patients alone can be as high as SAR 109.47 million (USD 29.19 million). Therefore, future studies should examine the factors contributing to long LOSs in PICUs and SCICUs as well as the effectiveness of different policies aimed at improving the resource allocation and management using more robust study designs and diverse patient population.
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